Comorbid disorders and therapy of persistent postural perceptual dizziness

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In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.

Chronic dizziness: modern treatment methods taking into account comorbidity

Zastenskaia,

Antonenko

2023

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Functional dizziness: from diagnostic criteria to clinical profiles and therapy. Expert consensus

Zamergrad,

Parfenov,

Ostroumova

et al. 2024

Functional dizziness (FD) is the most common form of chronic dizziness, accounting for up to 20% of all cases of chronic dizziness and is diagnosed in 40% of patients referred to specialized clinics. This article discusses the pathogenesis, clinical manifestations and diagnostic features of FD. An overview of standard and new methods of drug therapy and methods of vestibular rehabilitation for patients with FD is provided. Experts conclude that FD, currently defined as persistent postural perceptual dizziness (PPPD), is the most common cause of chronic non-rotational dizziness. PPPD is thought to be multifactorial; central and peripheral vestibular disorders, anxiety disorders and traumatic brain injury are noted as possible precipitating causes. The diagnosis of PPPD is based on the presence of a feeling of unsteadiness or non-rotational dizziness occurring more than half of the days over a period of three months or longer, when other possible causes of dizziness have been ruled out. When managing a patient with PPPD, it is necessary to inform the patient about the nature of the disease, provide a patient with an education program and apply psychotherapy and vestibular rehabilitation methods. The use of buspirone prolonged-release tablets (Vespirate®) and vestibular rehabilitation in clinical practice is discussed.

Dizziness in elderly patients: discussion based on a clinical observation

Kosivtsova,

Starchina,

Urtenov

et al. 2024

In elderly patients, vestibular disorders are often associated with concomitant diseases and lead to falls and injuries. When treating elderly patients, it is necessary to determine an underlying cause of dizziness, and assess concomitant diseases, medications taken and their possible impact on the course of the underlying disease. In elderly patients, vascular dizziness is often misdiagnosed, while peripheral causes of dizziness are not identified, and effective treatment is not provided. Early recognition and prompt treatment of acute dizziness are important to reduce the incidence of residual dizziness, especially in elderly patients at risk of falling. In this article, we present a case of an elderly patient with acute vestibular dizziness due to benign paroxysmal positional vertigo (BPPV) against a background of comorbid orthostatic hypotension. For a long time, the patient's vertigo was mistakenly recognized as a manifestation of cerebrovascular disease. The combination of peripheral vestibulopathy with orthostatic hypotension led to a fall and injury. Recognition and effective treatment of BPPV (Epley maneuver), elimination of hypotension by optimizing antihypertensive therapy and the use of Arlevert resulted in a sustained positive effect. The efficacy of Arlevret in elderly patients is discussed.